title: Parental education associations with children's body composition: mediation effects of energy balance-related behaviors within the ENERGY-project.
abstract: BACKGROUND
  It is well known that the prevalence of overweight and obesity is considerably higher among youth from lower socio-economic families, but there is little information about the role of some energy balance-related behaviors in the association between socio-economic status and childhood overweight and obesity. The objective of this paper was to assess the possible mediation role of energy balance-related behaviors in the association between parental education and children's body composition.
  
  
  METHODS
  Data were obtained from the cross sectional study of the "EuropeaN Energy balance Research to prevent excessive weight Gain among Youth" (ENERGY) project. 2121 boys and 2516 girls aged 10 to 12 from Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia and Spain were included in the analyses. Data were obtained via questionnaires assessing obesity related dietary, physical activity and sedentary behaviors and basic anthropometric objectively measured indicators (weight, height, waist circumference). The possible mediating effect of sugared drinks intake, breakfast consumption, active transportation to school, sports participation, TV viewing, computer use and sleep duration in the association between parental education and children's body composition was explored via MacKinnon's product-of-coefficients test in single and multiple mediation models. Two different body composition indicators were included in the models, namely Body Mass Index and waist circumference.
  
  
  RESULTS
  The association between parental education and children's body composition was partially mediated by breakfast consumption, sports participation, TV viewing and computer use. Additionally, a suppression effect was found for sugared drinks intake. No mediation effect was found for active transportation and sleep duration. The significant mediators explained a higher proportion of the association between parental education and waist circumference compared to the association between parental education and BMI.
  
  
  CONCLUSIONS
  Tailored overweight and obesity prevention strategies in low SES preadolescent populations should incorporate specific messages focusing on the importance of encouraging daily breakfast consumption, increasing sports participation and decreasing TV viewing and computer use. However, longitudinal research to support these findings is needed.
authors.affiliation: EMGO Institute for Health and Care Research and the Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Fernández-Alvira
authors.forename: Saskia J
authors.initials: SJ
authors.lastname: te Velde
authors.forename: Ilse
authors.initials: I
authors.lastname: De Bourdeaudhuij
authors.forename: Elling
authors.initials: E
authors.lastname: Bere
authors.forename: Yannis
authors.initials: Y
authors.lastname: Manios
authors.forename: Eva
authors.initials: E
authors.lastname: Kovacs
authors.forename: Natasa
authors.initials: N
authors.lastname: Jan
authors.forename: Johannes
authors.initials: J
authors.lastname: Brug
authors.forename: Luis A
authors.initials: LA
authors.lastname: Moreno
mesh_terms: D001823:Body Composition; D015992:Body Mass Index; D062408:Breakfast; D002648:Child; D002652:Child Behavior; D003201:Computers; D003430:Cross-Sectional Studies; D004032:Diet; D019422:Dietary Sucrose / Q000008:administration & dosage; D004522:Educational Status; D005060:Europe; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D009765:Obesity / Q000209:etiology; D010290:Parents; D012890:Sleep; D013177:Sports; D011795:Surveys and Questionnaires; D013690:Television; D014186:Transportation; D055105:Waist Circumference
chemical_list: D019422:Dietary Sucrose